Medicare AdvantagePrior AuthMedium impact
MA08.161d, Retifanlimab-dlwr (Zynyz®)
Independence Blue Cross·Oncology·Pharmacy
Effective date
May 4, 2026
We identified it
Jun 19, 2026
Summary
Medicare Advantage plans have updated medical necessity criteria for Retifanlimab-dlwr (Zynyz®), a cancer immunotherapy drug. This change affects prior authorization requirements and coverage criteria for this specialty oncology medication.
Action Required
By May 4, 2026: Oncology billing teams must review and update prior authorization procedures for Retifanlimab-dlwr (Zynyz®) according to new medical necessity criteria. Contact Medicare Advantage plans to obtain updated prior auth forms and requirements. Ensure providers document medical necessity per new criteria to avoid claim denials.